鼻窦炎：对抗生素无反应

ewenwen2007

Placebo As Good As Common Treatments For Sinus Infections

A placebo is likely to be just as effective as common acute sinusitis treatments involving a topical steroid and an antibiotic, according to an article published in the Journal of the American Medical Association (JAMA), 5th December issue.

Sinus infection (acute sinusitis) is often diagnosed and treated without clinical information, even though it is a common clinical problem which has symptoms similar to those found in other illnesses, the authors explain.

92% of patients in the UK and 85-98% of those in the USA are prescribed antibiotics, even though a bacterial cause is uncertain. The writers say \"Because there are no satisfactory studies of microbiological etiology from typical primary care patient practices, wide-scale overtreatment is likely occurring.\"

The widespread use of antibiotics may be having an impact on raised antibiotic resistance rates in the community. While topical steroids are commonly used to treat acute sinusitis, research on their effectiveness has been limited.

Ian G. Williamson, M.D., of the University of Southampton, England, and team carried out a double-blind randomized placebo-controlled trial to find out how effective amoxicillin (an antibiotic) and budesonide (a topical steroid) were for the treatment of acute maxillary sinusitis (rhinosinusitis - inflammation of the nasal cavity and sinuses).

240 adult patients were included in the trial. They all had non-recurrent sinusitis and were being treated at 58 GP (General Practitioner) practices, during the period Nov 2001 - Nov 2005.

They were randomly selected into one of four groups:

1. antibiotic and nasal steroid (500 mg of amoxicillin 3 times per day for 7 days and 200 μg of budesonide in each nostril once per day for 10 days)
2. placebo antibiotic and nasal steroid
3. antibiotic and placebo nasal steroid
4. placebo antibiotic and placebo nasal steroid

The researchers found that:

-- 29% of those receiving amoxicillin had symptoms lasting more than ten days
-- 36% of patients not receiving amoxicillin had symptoms lasting for more than ten days
-- 31.4% of those receiving topical budesonide had symptoms lasting for more than ten days
-- 31.4% of those not receiving budesonide had symptoms lasting for more than ten days

Further analysis found that nasal steroids were much more effective for those whose symptoms were less severe at baseline.

The researchers wrote \"Our main conclusions are that among patients with the typical features of acute bacterial sinusitis, neither an antibiotic nor a topical steroid alone or in combination are effective in altering the symptom severity, the duration, or the natural history of the condition. Topical steroids are likely to be effective in those with such features but who have less severe symptoms at presentation to the physician,\" the authors write.